POSTEROMEDIAL APPROACH TO THE DISTAL HUMERUS FOR TREATMENT OF THE MEDIAL COLUMN FRACTURES IN CHILDREN, TECHNICAL NOTE.

Aims: Exposure of the pediatric elbows for fixation of medial condylar and epicondylar fractures with or without dislocation is usually difficult through the direct medial approach due to the small sized elbows, associated marked edema which makes exposure of the ulnar nerve and direct visualization and reduction of the fracture difficult tasks in some cases, disruption of the ulnar collateral ligament and the flexor-pronator muscles during dissection, discomfort for the surgeon, improper insertion of Kirschnerwires for definite fixation through the incision which makes the skin closure difficult, lastly; some surgeons bend the K.wires in attempt to protrude them through the skin away from the incision which may sometimes affect the reduction. Methods: In order to overcome these difficulties we describe the posteromedial approach instead of direct medial approach for fractures which are actually posteromedial,this approach allows access to the fracture site by an incision directly over the ulnar nerve to avoid nerve traction or injury, it provides direct clear vision of the fracture site however the swelling is without disruption of ligaments,and allows easier insertion of K. wires through the intact skin away from the incision. Conclusion:- Posteromedial approach to medial condyle is a good surgical option for open reduction and pinning or fixation of medial condylar fractures in children. It is safe, easy, extensile with good exposure of both the ulnar nerve and fracture site, and with less complications.